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Ann Thorac Surg 2003;75:296
© 2003 The Society of Thoracic Surgeons

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Images in cardiothoracic surgery

Radical resection of a giant chondrosarcoma of the anterior chest wall

^a Division of Cardiothoracic and Vascular Surgery, "Hygeia" General Hospital, Athens, Greece

* Address reprint requests to Dr Kokotsakis, 12 Gr. Afxentiou Str, Kifisia, 145 62 Athens, Greece
e-mail: kokotsakis{at}internet.gr

A 54-year-old man presented with difficulty in breathing and a giant anterior chest wall tumor, which can be seen in this superior lateral view (Fig 1). The patient had a 10-year history of a slow-growing, painless anterior chest wall lump. On physical examination, the mass was hard, fixed, and nontender. Magnetic resonance imaging of the chest (Fig 2) showed a 20 x 25 cm anterior chest wall mass, protruding into the anterior mediastinum and both the left and the right hemithorax. An incisional biopsy of the tumor established the diagnosis of chondrosarcoma. The patient underwent a radical en block resection of a 24 x 29 cm segment of anterior chest wall including all of the gross tumor and 4 cm of macroscopically normal surrounding tissue. The microscopic evaluation of the margins by frozen sections was negative. The large chest wall defect was reconstructed in two layers, the first with a Gore-Tex (W. L. Gore & Assoc, Flagstaff, AZ) patch and the second with a composite of Marlex mesh (Bard Limited Crawley, United Kingdom) and methyl methacrylate, in order to confer adequate stability and avoid "flail" physiology. A postoperative computed tomographic scan (Fig 3) demonstrates the two-layer repair. Histopathology confirmed completely resected low-grade chondrosarcoma. The patient received assisted ventilation with limited peak airway pressures for 12 hours postoperatively. He had an uneventful recovery and was discharged home 7 days after surgery. He is doing well at the 12-month follow-up visit.

View larger version (98K): [in this window] [in a new window]   Fig 1.

View larger version (115K): [in this window] [in a new window]   Fig 2.

View larger version (124K): [in this window] [in a new window]   Fig 3.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Michael C. Milonakis Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Lioulias, A. G. Articles by Boulafendis, D. G. Search for Related Content PubMed PubMed Citation Articles by Lioulias, A. G. Articles by Boulafendis, D. G. Related Collections Chest wall